July 27, 2020

Physical Disability and Mortality in Older Adults with Type 2 Diabetes: A Justification for Exercise

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By David Taylor, PhD, PT
Department of Physical Therapy
University of Central Arkansas


Type 2 diabetes is a chronic, metabolic disease characterized by hyperglycemia resulting from insulin resistance.  Research studies indicate that complications such as cardiovascular disease,1 peripheral vascular disease, 2 retinopathy, 3 and loss of physical function 4 are associated with type 2 diabetes.  In regards to physical function, diabetes in older adults is associated with a strong increase in the risk of physical disability (odds ratio = 1.71; risk ratio = 1.51).5

Additional complications of type 2 diabetes are reductions in muscle strength and exercise capacity.  The results of previous studies suggest that people with type 2 diabetes have less muscle strength than people without type 2 diabetes. 6,7 Deficits in muscle strength are clinically relevant for people with type 2 diabetes due to evidence indicating that loss of muscle strength has been associated with increased risk of physical disability. 8,9  Research also suggests that people with type 2 diabetes have decreased exercise capacity as compared to people without type 2 diabetes. 10,11 Loss of exercise capacity is clinically important for people with type 2 diabetes since loss of exercise capacity has been shown to increase the risk of mortality. 12-14

The findings of previous research studies provide supportive evidence for the use of exercise programs to improve muscle strength, 15-17 exercise capacity,16,17 and physical function17 in people with type 2 diabetes.  Professional organizations such as the American Diabetes Association and American College of Sports Medicine have published exercise guidelines for type 2 diabetes due to such strong evidence.  The following information can be used as a reference for clinically feasible physical function assessments and evidence-informed exercise recommendations when providing care for older adults with type 2 diabetes.


Physical Function Assessments
Assessment Reference
Patient-specific Functional Scale Mathis et al.
Activities-specific Balance Confidence Scale Powell and Myers
Short Physical Performance Battery Guralnik et al.
Berg Balance Scale Steffen et al.
Timed Up and Go Steffen et al.


Exercise Recommendations
Professional Organization Reference
American Diabetes Association and American College of Sports Medicine

Joint Position Statement

Colberg et al.
American Heart Association Marwick et al.




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